Provider Demographics
NPI:1073829891
Name:KHASKILEVICH, YEVGENIYA ALEKS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YEVGENIYA
Middle Name:ALEKS
Last Name:KHASKILEVICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:YEVGENIYA
Other - Middle Name:ALEKS
Other - Last Name:KOLOMIYETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:701 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-4600
Mailing Address - Fax:480-247-3989
Practice Address - Street 1:3460 WASHINGTON DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4302
Practice Address - Country:US
Practice Address - Phone:651-769-6200
Practice Address - Fax:651-769-6249
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10864363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4692OtherPA LIC